The lipid-heart hypothesis from the Seven Countries Study of Cardiovascular Diseases

Area of Science:

• Cardiovascular Epidemiology
• Nutritional Science
• Biostatistics

Background:

• The Seven Countries Study (SCS) provides extensive data on cardiovascular disease (CVD) mortality.
• Dietary fatty acid composition is a key factor influencing CVD risk.
• Atherogenicity Index (ATI) and Thrombogenicity Index (THI) are composite scores reflecting dietary fat quality.

Purpose of the Study:

• To evaluate the predictive power of ATI and THI for major CVD and coronary heart disease (CHD) mortality.
• To analyze long-term mortality trends using ecological data from 16 cohorts.
• To assess the association of dietary patterns with CVD mortality.

Main Methods:

• Ecological analysis of 16 cohorts from the Seven Countries Study.
• Calculation of Atherogenicity Index (ATI) and Thrombogenicity Index (THI) based on dietary fatty acids.
• Correlation analysis between dietary scores (e.g., Mediterranean Adequacy Index - MAI), ATI, THI, serum cholesterol, and CHD mortality over 50-60 years.

Main Results:

• A strong inverse correlation was observed between the Mediterranean Adequacy Index (MAI) and ATI (R = -0.91).
• ATI showed a direct correlation with serum cholesterol (R = +0.73), which in turn correlated with 50-year CHD mortality (R = +0.78).
• Both MAI (R = -0.91) and ATI (R = +0.93) were strongly correlated with CHD mortality, with THI yielding comparable results. These associations were specific to CHD and not observed for other CVD fatalities like stroke.

Conclusions:

• The ATI and THI indices, derived from dietary fatty acid composition, are robust predictors of long-term coronary heart disease (CHD) mortality.
• These dietary indices are not significantly associated with mortality from other major cardiovascular disease (CVD) types, including stroke.
• The findings underscore the critical role of dietary fat quality in CHD pathogenesis and mortality.